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 Express Scripts, the largest manager of prescription drug plans for
U.S. employers, on Tuesday said year-over-year spending per person
for individual insurance plans sold on the Obamacare exchanges where
it manages the pharmacy benefit rose 14 percent in 2016, driven by
higher drug prices and utilization.
Express Scripts said per-capita spending for other commercial plans
it manages, mostly for employers, rose just 3.8 percent last year,
despite an 11 percent increase in list prices for brand-name drugs.
Drug spending for plans the company manages under Medicare, the
federal government health plan for seniors and disabled, increased
4.1 percent last year while the rise for Medicaid, the government
plan for the poor, was 5.5 percent.
Prescription medications for chronic, costly conditions drove drug
benefit usage with high-cost specialty medications - including drugs
for HIV and inflammatory conditions - accounting for nearly half of
total drug spending for exchange plans, the company said.
President Donald Trump and congressional Republicans have vowed to
repeal and replace the Affordable Care Act, former President Barack
Obama's signature piece of domestic policy known as Obamacare, but
have not yet released details. Last year was the third full year of
operation for the exchanges.
Drug pricing has become a lightning rod for criticism with several
drugmakers under federal investigations for sharp price increases.
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Pharmacy benefit managers like Express Scripts have taken an
increasingly aggressive stance in price negotiations with drugmakers,
often extracting discounts and after-market rebates in exchange for
including medicines in their formularies with low co-payments. But
they have also been criticized by pharmaceutical companies, which
say they add to their product costs.
Express Scripts said exchange plans, to remain more competitive,
tend to have more inclusive formularies than other commercial plans.
"Drug policy is always complicated," said Express Scripts Chief
Medical Officer Steve Miller. "New people coming into CMS (Centers
for Medicare & Medicaid Services) and FDA (Food and Drug
Administration) will hopefully be able to embrace changes."
(Reporting By Deena Beasley; Editing by Cynthia Osterman)
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